Signs of an ectopic ovarian pregnancy. Ovarian pregnancy: causes of pathology, symptoms, diagnosis, ultrasound with photos, necessary treatment and possible consequences

Most modern women are familiar with the concept of “ectopic pregnancy,” but not everyone knows where it can develop, what its symptoms are and possible consequences. In this article we will look at what ovarian pregnancy is, its signs and treatment methods.

Definition

Ovarian pregnancy is fertilization that occurred at a time when the egg has not yet had time to leave the dominant follicle. In this case, it attaches to the ovary without entering the cavity of the fallopian tube and without inserting into the uterus. Ovarian pregnancy can be of two types:

Both are equally dangerous to a woman’s life and health.

Causes

In most cases, ectopic pregnancy occurs for no apparent reason, but experts identify the following factors that can lead to improper attachment of the egg:

1. The woman has a past or present history of infectious diseases that have negatively affected the reproductive system.
2. Carrying out operations on the uterus or appendages.
3. Acquired or congenital obstruction of the fallopian tubes.
4. Hormonal disorders.
5. The presence of benign or malignant neoplasms in the uterus or fallopian tubes.
6. Anomalies in the development of internal genital organs.
7. Genetic disorders.

In addition, such a pathology can occur if a woman has been given the wrong therapy for infertility.

Symptoms

An ovarian ectopic pregnancy may present with the following symptoms:

In addition, with such a pregnancy, all the symptoms of a uterine pregnancy are observed - delayed menstruation, nausea, vomiting, swelling and tenderness of the breasts. It is pain in an unusual place that should alert a woman and serve as a reason to contact a gynecologist. If the painful symptoms of ovarian pregnancy worsen, urgent hospitalization is necessary, as they may indicate ovarian rupture.

Diagnostics

To determine an ectopic pregnancy of the ovarian type, an integrated approach is required:

1. A medical interview and examination, during which the symptoms that occur in a woman are clarified.
2. Ultrasound of ovarian pregnancy can help in making the correct diagnosis. However, unfortunately, this method does not provide a 100% guarantee. This is due to the fact that the fertilized egg is similar to a cystic formation.
3. To avoid the possibility that the cyst turns out to be an ovarian pregnancy, diagnostic laparoscopy is prescribed - a minimally invasive operation that is performed using a laparoscope.

Blood is also donated for hCG and a general urine test is performed. Despite the fact that during an ultrasound of an ovarian pregnancy, a photo of which is given immediately, it may appear to be a cyst or other neoplasm. The doctor pays attention to the increased level of the hCG hormone in the blood and the presence of delayed menstruation, as well as characteristic pain when pressing on the abdomen on the side on which the fertilized egg is attached.

Treatment

Unfortunately, for this pathology, only surgical elimination of the problem is indicated. The removal method is selected depending on the following factors:

• the woman’s desire to have children in the future;
• the size of the fertilized egg;
• condition of the ovary (intact or burst).

Most often, instead of open abdominal surgery, laparoscopy is performed:

• The device is inserted into the abdominal cavity through small incisions;
• an incision is made on the ovary;
• the fertilized egg is removed;
• instruments are removed and sutures are applied.

In most cases, such operations are successful and the natural functions of the organ are preserved. Exceptions occur only when the symptoms of ovarian pregnancy were noticed too late and the fertilized egg increased to a large size. In this case, the ovary bursts, which is an indication for its removal. Ovarian pregnancy, like any other ectopic pregnancy, cannot be considered a normal condition - it is a pathology that requires urgent surgical intervention.

Preparing for surgery

Despite the fact that surgical intervention using laparoscopy is low-traumatic, a woman must still undergo certain training, which includes the following points:

If emergency surgery is necessary, laparoscopy is replaced by abdominal surgery.

Postoperative period

The time after laparoscopy or abdominal surgery is very important for the proper healing of damaged internal organs. The postoperative period consists of taking the following medications:

• painkillers;
• antibiotics to prevent the development of bacterial infection;
• anti-inflammatory drugs to relieve inflammation.

Discharge time after laparoscopy occurs after 3-4 days of hospitalization, and after open surgery it is about two weeks. During this time, doctors monitor the woman’s condition and the healing of the sutures.

In addition, after surgery it is important to monitor the level of hCG, since the fertilized egg may not be completely removed. A tumor may subsequently develop from it. Normally, the hCG level decreases by 50% 2-3 days after surgery.

Rehabilitation

Ectopic pregnancy is a rather complex pathology that requires a long recovery period, especially if the woman is planning a pregnancy in the future. Along with taking the medications prescribed after the operation, the patient must monitor her diet: on the first day, only drinking water is allowed, on the second day, drinking yoghurt is allowed, on the third day, it is possible to switch to easily digestible foods - porridge, broth, boiled meat and fish, crackers.

For a speedy recovery of the body, the following physiotherapy procedures may be indicated:

• magnetic therapy;
• electrophoresis;
• ultrasound therapy;
• mud baths;
• paraffin therapy.

During the period of several weeks after the operation, any physical activity, even the most insignificant, is completely prohibited. It is strictly forbidden to lift heavy objects.

Resumption of sexual activity is allowed only a month after laparoscopic surgery and 3 months after abdominal surgery. In this case, a woman should be protected with oral contraceptives, which will not only prevent pregnancy, but also help restore hormonal levels. Mandatory contraception using medications is necessary for 6-9 months after surgery. Only after this period is a new pregnancy possible. There is also a high probability of infection in the postoperative period, so doctors advise using condoms with every sexual intercourse.

In addition to the generally accepted norms of diagnostic measures described above, I would like to pay attention to an integral part of the treatment of ectopic pregnancy - differential diagnosis of the disease. A thorough medical examination, of course, will help to be 100% sure that the woman has a pathologically developing pregnancy, especially here a transvaginal ultrasound examination will help out. However, any qualified gynecologist will not begin complex treatment of pathology until he has carried out a differential diagnosis of ovarian ectopic pregnancy with other gynecological and surgical diseases.

What is the differential diagnosis and how does it relate to ovarian ectopic pregnancy? The fact is that a number of symptoms accompanying the active development of an ectopic pregnancy in the ovary coincide with the symptoms of many diseases in which the clinical picture of an “acute abdomen” is pronounced. Therefore, as you already understand, differential diagnosis is a method of diagnostic measures to exclude inappropriate signs of one or another disease in relation to the main one, which is actually suspected from the very beginning. This technique is actively used not only in gynecology, but also in other areas of medicine - therapy, surgery, neurology, etc. It cannot be said that this is one of the key points when making a diagnosis, however, as an additional diagnostic method - differential. The diagnosis worked well!

So, what diseases are compared based on the patient’s symptoms?

The most striking example of this is ovarian apoplexy - a pathology of the appendages, namely the ovaries. In common parlance, this disease is known as ovarian rupture. But, despite the fact that the clinical picture of the acute development of an interrupted ectopic pregnancy is similar to the clinical picture of ovarian apoplexy, there are some features that make it possible to reject a possible diagnosis. To begin with, a pregnancy test previously conducted at home or in a hospital will show a negative result, while in the case of an ectopic pregnancy the test is positive or weakly positive. A characteristic sign of ovarian rupture is its onset approximately in the middle of the menstrual cycle, and if a corpus luteum cyst ruptures, gynecologists determine that the woman is in the second phase of the cycle. While with an ectopic pregnancy, there is no menstruation at all (with the exception of some situations). Accordingly, on the eve of the onset of symptoms of ovarian apoplexy, the woman could not observe herself for any signs of pregnancy, as happens with an ectopic ovarian pregnancy.

The second most important pathological condition of a woman, which can be compared or mistaken for an ovarian ectopic pregnancy, is spontaneous miscarriage. No one can 100% foresee the development of possible complications, such as termination of pregnancy. If such a situation occurs, gynecologists conduct a thorough medical examination and differential diagnosis to develop the most effective comprehensive treatment for the patient. So, if a woman with a suspected ectopic pregnancy is admitted to the hospital, the examination excludes the following symptoms confirming spontaneous abortion:

1. Absence of any symptoms of blood loss (intra-abdominal),
2. External bleeding from the woman's genitals, consistent with her appearance, all signs indicate that significant blood loss has occurred,
3. A characteristic feature of discharge from the genitals is blood, the consistency of which resembles that from scanty to abundant, with the presence of clots. And it appears before the woman complains of pain in the lower abdomen, the color of the discharge is bright scarlet.
4. A gynecological examination shows that the abdomen is soft, and the examination is painless for the woman, there is no symptom of irritated peritoneum,
5. All signs of pregnancy corresponding to the gestational age, opening of the cervical canal, ultrasound examination shows a fertilized egg in the uterine cavity.

These and many other diagnoses that may indicate a possible ectopic pregnancy or a similar disease with characteristic symptoms. Differential diagnosis is also carried out with appendicitis, dysfunctional uterine bleeding and simply inflammatory diseases of the female reproductive system, which are the root cause of ectopic pregnancy in the future. In critical gynecological conditions, all diseases are interconnected and, one way or another, pass from one pathology to another, or acquire the nature of a chronic disease, therefore, timely prevention of gynecological and surgical diseases will reduce the risk of ovarian ectopic pregnancy as much as possible.

Ovarian ectopic pregnancy treatment

Despite the wide range of treatment methods in gynecology and other branches of medicine, the main, most effective way to eliminate an ovarian ectopic pregnancy is still surgical intervention to remove the affected tissue and excision of the fertilized egg, to maximize the integrity of the organ.

I would just like to add that thanks to technological progress, today even such a serious surgical intervention is much easier and painless, thanks to endoscopic surgery. Thus, the duration of many operations has been reduced several times, the development of infectious postoperative complications has decreased by 30%, and the issue of beauty, especially for women, has become less acute and painful, since, unlike laparotomy, endoscopic surgery does not leave visible scars and scars for many years, maintaining the aesthetic appearance of the operated field.

The pathology discussed in this article refers to one of the types of ectopic fertilization of the egg. Ovarian pregnancy is diagnosed quite rarely and accounts for only up to one percent of all cases of ectopic pregnancy.

ICD-10 code

O00.2 Ovarian pregnancy

Causes of ovarian pregnancy

This clinical picture is observed if the egg does not have time to leave the ovary and is released from the follicle, but has already been fertilized by a sperm. Further planned maturation of the egg begins, while it no longer moves further, but continues to develop, attached to the ovary.

There are no changes in a woman’s body that lead directly to the pathology in question, but we can speak, in general, about sources that can provoke various types of ectopic pregnancy.

The causes of ovarian pregnancy vary. As studies and observations conducted in this area have shown, the deviation in question from the normal course of pregnancy can be provoked by:

• A previous infectious disease that occurred in the uterine tissue, as well as in the case of inflammation of the endometrium.
• Colds of the genital organs.
• With the development of obstruction of the fallopian tubes.
• This may be the consequences of surgery performed on the pelvic organs or genitals.
• Ovarian pregnancy can be triggered by changes affecting the genetic and endocrine areas of the human body.
• The presence of a cyst or polycystic formations.
• Congenital or acquired underdevelopment of the ovary.
• Consequences of medical therapy with the use of potent medications.
• Therapy carried out to rid a woman of infertility.

As observations have shown, nine out of ten cases occurred without any obvious reasons, that is, ovarian pregnancy developed “accidentally.”

Symptoms of ovarian pregnancy

The course of pregnancy of the type in question is progressing, without any negative symptoms. The development of the embryo itself proceeds without obvious deviations, with virtually no deviations from a natural intrauterine pregnancy. Even in the later stages, the woman begins to feel the baby moving. Such periods are achieved due to the fact that the ovarian tissue is quite elastic and capable of stretching to a certain point. But such an idyll occurs for the time being.

At the moment when the size of the embryo has reached critical parameters (the walls of the ovary are not able to stretch further, having reached their limit), the woman begins to feel the symptoms of ovarian pregnancy, which begin to appear:

• The appearance of obvious signs of early toxicosis.
• Enlargement of the mammary glands and their increased pain.
• Prolonged spotting and spotting from the vagina.
• Severe pain in the lower abdomen, point pain localized at the site of pregnancy.
• The pain begins to gradually radiate to the lumbar region and/or large intestine (anus). An attack can last from a few minutes to a number of hours. During the attack, weakness, dizziness, and nausea appear.
• A sharp drop in blood pressure.
• The appearance of painful bowel movements.
• The pregnant woman's body goes into a faint or pre-fainting state.

Somewhat later, when the size of the fetus has increased further, the woman begins to experience internal bleeding and the pain becomes more intense. Its increase can provoke loss of consciousness from painful shock. This symptomatology may be accompanied by an increase in the woman’s body temperature. The complex of manifestations listed above indicates organ rupture.

Even at the first appearance of a uncomfortable condition, a pregnant woman should seek advice from her obstetrician - gynecologist who is leading the pregnancy. And if the situation gets out of control and the symptoms worsen, it is necessary to urgently call an ambulance.

Diagnosis of ovarian pregnancy

It is necessary to immediately clarify the fact that ectopic pregnancy, and specifically the type of its development discussed in this article, is very dangerous. It poses a threat not only to the health of the unborn baby and his mother, but also increases the risk of death for the woman.

In most cases, the child does not survive, but timely provision of medical care to the victim increases the woman’s chances of survival. After all, at the moment of rupture of the ovary, severe bleeding occurs. And if it is not stopped in time, the patient will simply bleed to death.

Therefore, even at the slightest suspicion of an ectopic pregnancy, the woman in labor must be immediately hospitalized. A sharp, acute pain in the iliac region allows one to suspect an internal rupture. Mostly, such symptoms occur four weeks after the moment of a missed period - but this is not a dogma.

At the same time, a visual examination of a woman by an obstetrician-gynecologist on a chair using a special mirror shows the doctor the softness of the tissues of the uterus and its cervix (which indicates the presence of pregnancy). At the same time, their tint gives off a bluish tint.

During palpation, an experienced gynecologist determines a unilateral increase in size and increased soreness of the ovary. In this case, the organ is not clearly contoured.

The specialist begins to compare the time of the last menstruation and the size parameters of the uterus. Their discrepancy is the reason for prescribing a targeted additional examination.

Accuracy in making the correct diagnosis is only possible with the help of an ultrasound examination of the woman’s genital organs. The diagnostician, using a special medical device, carefully examines the pelvic organs, the uterine cavity, and the condition of the endometrium. Ultrasound allows you to identify the fertilized egg and the place of its attachment.

If, despite all the signs of pregnancy, the embryo is not found in the uterus, and the diagnostician observes the presence of blood clots and fluid in the peritoneal cavity or in the area behind the uterus, the doctor makes a diagnosis of ectopic pregnancy.

A pregnant woman must also undergo a urine and blood test to determine the content of human chorionic gonadotropin (hCG), as well as to determine the level of progesterone. Human chorionic gonadotropin is a special hormonal protein produced by the membrane cells of the growing fetus throughout gestation. Its presence and sufficient quantity allows you to maintain the normal course of pregnancy. It is hCG that inhibits the process that provokes the appearance of menstruation, allowing you to save the baby.

There are certain standards by which comparisons are made. At the same time, a qualified specialist knows that the progesterone level in the case of an ectopic pregnancy is slightly lower than in the case of a normal pregnancy.

The test is repeated after 48 hours. At the same time, hCG indicators are compared. If its characteristics remain unchanged, then this fact only confirms ectopic fertilization of the egg.

Ovarian pregnancy on ultrasound

After registering the expectant mother with a gynecologist at the antenatal clinic, the specialist must prescribe an ultrasound of the uterus for his patient. This study, carried out in the early stages of pregnancy, should protect against the further development of any pathological abnormality.

It should also be noted that a clinical picture may arise when the test showed two stripes, which corresponds to a positive response to fertilization of the egg, while an ultrasound examination says the opposite - there is no embryo in the uterus. This discrepancy is one of the indications of a developing ectopic pregnancy.

Therefore, the research is carried out more carefully. Ovarian pregnancy is determined by ultrasound if the fertilized egg is located in the projection of the ovary. In this case, the diagnostician usually observes that the embryo and the uterus are directly connected by the ovarian ligament.

But it’s worth reassuring women a little. The presence of pain symptoms is not a mandatory indicator of ovarian pregnancy. This symptomatology can also manifest itself as a result of a number of other diseases (for example, polycystic disease).

Treatment of ovarian pregnancy

If there is even a slight deterioration in the pregnant woman’s health, she should immediately consult her obstetrician-gynecologist for examination. If a woman’s condition rapidly deteriorates, urgent medical attention is needed.

If an ectopic pregnancy is not detected in a timely manner, then after some time (usually this period is about a month), the pregnant woman may experience acute abdominal pain and uterine bleeding.

In such a situation, the clock is already counting down to hours and minutes.

Today, depending on the severity of the clinical picture of the pathology, doctors have two methods for treating ovarian pregnancy: surgery and drug therapy.

In light of drug treatment, medications of a certain pharmacological nature are taken. One of these drugs is methotrexate, injections of which can provoke the death of the embryo and the resorption of tissues that have already formed. The use of this medicine allows you to keep the ovaries and folic tube of the failed mother in a healthy state. This treatment enables the woman to conceive a child again in the future and carry it safely to term.

Today, this drug is not yet so actively used in the treatment of ectopic pregnancy: CIS countries provide only 5 to 8%, while this figure in foreign clinics ranges from 25 to 33%.

A cytostatic drug compound from the group of folic acid antagonists is prescribed by a doctor if a number of mandatory conditions are met:

• Stable hemodynamic condition of the pregnant woman.
• She has no hemodynamically severe bleeding.
• Ultrasound confirmed diagnosis - ectopic localization of the ovum.
• Lack of uterine location of the fertilized egg.
• No constant pain symptoms.
• If there are no contraindications for taking methotrexate.

At the same time, a medicinal method of treating ovarian pregnancy is possible only if an ultrasound examination shows the size parameters of the fetal egg no more than 3.5 mm, as well as human chorionic gonadotropin (hCG) readings below the level of 5000 mIU/ml.

Methotrexate is prescribed to a pregnant woman after diagnosing ectopic embryo development in the form of an injection solution administered intramuscularly or intravenously.

The injection is performed once. After three to four weeks, a woman usually starts her first period.

Surgical treatment involves a method of getting rid of the problem by curettage of the embryo. At the same time, the organ in which the fetus developed can be removed. In this case, the ovary.

Mostly, if the question arises about a surgical solution to the problem, a gynecologist surgeon performs an operation to remove the embryo and wedge resection of the ovary. In this case, partial excision of the ovary occurs. After some time, it completely restores its functions, allowing the woman to normally conceive, bear and give birth to a baby.

But if the situation has gone too far and doctors observe a severe clinical picture, surgical intervention will have more serious consequences. The surgeon has to perform an oophorectomy - an operation to remove the ovary involved in an ectopic pregnancy.

Prevention of ovarian pregnancy

Not a single representative of the fair sex of childbearing age is insured against ectopic pregnancy. But some recommendations that determine the prevention of ovarian pregnancy can still be given:

• It is worth practicing safe sex to prevent infection with sexually transmitted diseases. This will help protect the woman’s genitals from damage.
• Early diagnosis and timely treatment of sexually transmitted diseases.
• Maintaining a healthy lifestyle. Rejection of bad habits.
• If a woman is planning to have a child, but is at risk, it is worth visiting a gynecologist before conception, undergoing an examination and, after conception, being under constant medical supervision.
• If you experience the slightest discomfort during pregnancy, you should immediately contact a specialist for consultation and examination. The faster the pathology in question is detected, the easier the consequences of its relief.

If an unpleasant diagnosis has been made, it is now worth fighting to preserve the reproductive organs. To do this, without delay, you should:

• Conduct a urine test to determine the level of human chorionic gonadotropin (hCG), after two to three days this test should be repeated.
• It is necessary to undergo an ultrasound examination to determine the type of pregnancy: uterine or ectopic. Based on the results, undergo treatment if necessary.
• Self-diagnosis and self-medication in case of suspected pathological pregnancy are unacceptable. Losing time can cost a woman in labor not only her health, but also her life.

Ovarian pregnancy prognosis

If a woman is responsible for her health and the health of her unborn child, then at the slightest ailment she immediately turns to a qualified doctor. This step allows her to make the prognosis for ovarian pregnancy quite favorable. Subsequently, she remains fully capable of conceiving, bearing and giving birth to a healthy child. Statistics show that 50–85% of such women were able to become mothers in the future. 10 – 20% of cases show a repeat ectopic pregnancy.

If the situation is advanced and doctors observe a rather severe clinical picture of the pathology, aggravated by severe bleeding, then the risk of developing serious complications, or even death of the victim, increases sharply.

Not a single woman who wants to become a mother and give birth to a healthy baby is immune from the diagnosis of ovarian pregnancy. But the point is not that such a pathology can affect everyone, but to take timely and adequate measures to solve the problem. Therefore, it is better to play it safe and consult a doctor than to ignore the body’s signals and lose not only the baby, but also your health, and possibly your life. Therefore, dear women, be more attentive to your health and more responsible. After all, delaying seeking help from a qualified doctor can be too expensive. And you will have to pay with your health, and sometimes with your life!

It is important to know!

During pregnancy, a woman's body undergoes many changes. Some of them are visible to the naked eye, while others are so hidden that they can only be detected with the help of an ultrasound examination or laboratory diagnostics.

In addition to the generally accepted norms of diagnostic measures described above, I would like to pay attention to an integral part of the treatment of ectopic pregnancy - differential diagnosis of the disease. A thorough medical examination, of course, will help to be 100% sure that the woman has a pathologically developing pregnancy, especially here a transvaginal ultrasound examination will help out. However, any qualified gynecologist will not begin complex treatment of pathology until he has carried out a differential diagnosis of ovarian ectopic pregnancy with other gynecological and surgical diseases.

What is the differential diagnosis and how does it relate to ovarian ectopic pregnancy? The fact is that a number of symptoms accompanying the active development of an ectopic pregnancy in the ovary coincide with the symptoms of many diseases in which the clinical picture of an “acute abdomen” is pronounced. Therefore, as you already understand, differential diagnosis is a method of diagnostic measures to exclude inappropriate signs of one or another disease in relation to the main one, which is actually suspected from the very beginning. This technique is actively used not only in gynecology, but also in other areas of medicine - therapy, surgery, neurology, etc. It cannot be said that this is one of the key points when making a diagnosis, however, as an additional diagnostic method - differential. The diagnosis worked well!

So, what diseases are compared based on the patient’s symptoms?

The most striking example of this is ovarian apoplexy - a pathology of the appendages, namely the ovaries. In common parlance, this disease is known as ovarian rupture. But, despite the fact that the clinical picture of the acute development of an interrupted ectopic pregnancy is similar to the clinical picture of ovarian apoplexy, there are some features that make it possible to reject a possible diagnosis. To begin with, a pregnancy test previously conducted at home or in a hospital will show a negative result, while in the case of an ectopic pregnancy the test is positive or weakly positive. A characteristic sign of ovarian rupture is its onset approximately in the middle of the menstrual cycle, and if a corpus luteum cyst ruptures, gynecologists determine that the woman is in the second phase of the cycle. While with an ectopic pregnancy, there is no menstruation at all (with the exception of some situations). Accordingly, on the eve of the onset of symptoms of ovarian apoplexy, the woman could not observe herself for any signs of pregnancy, as happens with an ectopic ovarian pregnancy.

The second most important pathological condition of a woman, which can be compared or mistaken for an ovarian ectopic pregnancy, is spontaneous miscarriage. No one can 100% foresee the development of possible complications, such as termination of pregnancy. If such a situation occurs, gynecologists conduct a thorough medical examination and differential diagnosis to develop the most effective comprehensive treatment for the patient. So, if a woman with a suspected ectopic pregnancy is admitted to the hospital, the examination excludes the following symptoms confirming spontaneous abortion:

1. Absence of any symptoms of blood loss (intra-abdominal),
2. External bleeding from the woman's genitals, consistent with her appearance, all signs indicate that significant blood loss has occurred,
3. A characteristic feature of discharge from the genitals is blood, the consistency of which resembles that from scanty to abundant, with the presence of clots. And it appears before the woman complains of pain in the lower abdomen, the color of the discharge is bright scarlet.
4. A gynecological examination shows that the abdomen is soft, and the examination is painless for the woman, there is no symptom of irritated peritoneum,
5. All signs of pregnancy corresponding to the gestational age, opening of the cervical canal, ultrasound examination shows a fertilized egg in the uterine cavity.

These and many other diagnoses that may indicate a possible ectopic pregnancy or a similar disease with characteristic symptoms. Differential diagnosis is also carried out with appendicitis, dysfunctional uterine bleeding and simply inflammatory diseases of the female reproductive system, which are the root cause of ectopic pregnancy in the future. In critical gynecological conditions, all diseases are interconnected and, one way or another, pass from one pathology to another, or acquire the nature of a chronic disease, therefore, timely prevention of gynecological and surgical diseases will reduce the risk of ovarian ectopic pregnancy as much as possible.

Ovarian ectopic pregnancy treatment

Despite the wide range of treatment methods in gynecology and other branches of medicine, the main, most effective way to eliminate an ovarian ectopic pregnancy is still surgical intervention to remove the affected tissue and excision of the fertilized egg, to maximize the integrity of the organ.

I would just like to add that thanks to technological progress, today even such a serious surgical intervention is much easier and painless, thanks to endoscopic surgery. Thus, the duration of many operations has been reduced several times, the development of infectious postoperative complications has decreased by 30%, and the issue of beauty, especially for women, has become less acute and painful, since, unlike laparotomy, endoscopic surgery does not leave visible scars and scars for many years, maintaining the aesthetic appearance of the operated field.

An ectopic pregnancy is a pathological condition in which the fertilized egg develops outside the uterine cavity. In women, an abnormal pregnancy is considered as such if a fertilized egg begins to develop in the fallopian tube, peritoneum or ovary.

In approximately half of the cases of the development of this condition, it is not possible to establish the cause of its occurrence, however, experts in the field of gynecology identify several of the most characteristic predisposing factors.

The symptoms of pregnancy developing outside the uterus are practically no different from the course of the normal period of bearing a child. Nevertheless, there is a more pronounced expression of the symptoms and a sharp deterioration in the woman’s condition, which occurs against the background of the frequent development of complications.

In the early stages of the pathology, it is quite difficult to diagnose it, because it manifests itself with atypical symptoms. In cases of development of such consequences as rupture of the fallopian tube, rapid diagnosis is necessary, based on data from laboratory and instrumental examinations.

Ectopic pregnancy is treated only surgically - this is due to the high probability of death.

The fundamental factor in the development of ectopic pregnancy is considered to be the slow progression of the egg through the molasses tube. A fairly large number of pathological conditions can lead to such a disorder. The main causes of pathological pregnancy are expressed in:

• obstruction of the fallopian tube - this is often caused by the formation of scars, which in turn arise after a previous gynecological operation;
• hormonal imbalance;
• presence of an STD in your medical history;
• chronic salpingitis - in this case, an inflammatory process develops in the fallopian tube;
• the formation of malignant, cystic or benign neoplasms in the ovaries or body of the uterus;
• prolonged use of a method of contraception such as an intrauterine device, which very often leads to inflammation;
• a history of such a disease - repeated ectopic pregnancy develops in approximately 10% of all cases;
• anatomical anomalies in the structure of the fallopian tubes;
• artificial insemination - in 3% of cases after IVF a similar disease is observed;
• respiratory diseases that involve the organs of the reproductive system in the pathological process;
• diseases of the endocrine system, in particular the thyroid gland or adrenal glands;
• uncontrolled use of potent medications;
• previous terminations of pregnancy using medical abortion;
• artificial stimulation of ovulation - a similar process is carried out before in vitro fertilization;
• delayed sexual development;
• genital infantilism or endometriosis.

In some cases, attempts to find out the causes of ectopic pregnancy remain unsuccessful.

Classification

Pathological pregnancy in gynecology is considered a rather rare disorder, which is diagnosed in approximately 2% of all cases. Nevertheless, such standing can occur in several forms and is divided into:

1. tubal pregnancy - in which the fertilized egg attaches to the wall of the fallopian tube. This is the most common variety, with rates reaching almost 98%. Often, the causes of tubal pregnancy lie in developmental anomalies, previous operations and the presence of neoplasms of various types.
2. ectopic pregnancy in the ovary – its percentage reaches 1.3%. It is divided into several forms - intrafollicular and ovarian.
3. abdominal pregnancy – occurs in no more than 1.4%. It is formed against the background that a fertilized egg, when released into the abdominal cavity, can attach to the peritoneum, intestines or other internal organs located nearby. The most common cause of this type of ectopic pregnancy is IVF.
4. cervical pregnancy – does not exceed 0.4%. In addition to the characteristic signs, the clinical picture is dominated by profuse hemorrhage.
5. pregnancy in the accessory horn of the uterus - accounts for 0.9% of all cases of detection of such a disease and develops due to abnormalities in the structure of the uterus, which can be either congenital or acquired.
6. intraligamentous - this type of ectopic pregnancy is one of the rarest, since it is found only in 0.1% of cases. It is characterized by the fact that the development of the fertilized egg occurs in the cavity located between the leaves of the broad ligaments of the uterus. An egg can enter this area if the fallopian tube ruptures.
7. heterotopic is a pathological course of multiple pregnancy, in which one fertilized egg is attached to the uterus, and the others outside it.

Symptoms

At the initial stages of the development of an ectopic pregnancy of any type, similar clinical manifestations will appear as during the normal course of the gestation period. It is for this reason that it can be quite difficult to make a correct diagnosis, and women are in no hurry to seek qualified help.

The combination of such factors leads to the fact that the problem worsens, the patient’s condition worsens and, ultimately, profuse internal bleeding develops, which can cause death.

Thus, the first signs of an ectopic pregnancy are considered to be:

• menstrual irregularities;
• nausea, vomiting and other manifestations of toxicosis;
• spotting bloody discharge from the vagina;
• soreness in the lower abdomen. The localization of unpleasant sensations can also be located on the side of the attachment of the fertilized egg;
• decreased appetite;
• frequent mood changes;
• engorgement of the mammary glands.

In addition, it is worth highlighting the most characteristic symptoms for some types of the disease. So, tubal pregnancy will correspond to:

1. pain syndrome, expressed in constant and cutting pain.
2. irradiation of pain to the perineum, pelvic area and lower back.
3. temperature increase.
4. nausea without vomiting.
5. causeless weakness and increased fatigue.
6. aversion to food.
7. diarrhea.
8. profuse bleeding - this may indicate a ruptured fallopian tube.
9. rapid but weak pulse.
10. periods of loss of consciousness.
11. an increase in the size of the abdomen, which is associated with the accumulation of a large amount of blood in the peritoneum when the fallopian tube breaks.

Symptoms of ovarian pregnancy include:

• early appearance of severe toxicosis;
• pain during emptying the bladder or during bowel movements;
• excessive tenderness of the mammary glands;
• pre-fainting;
• significant decrease in blood pressure;
• point pain in the lower abdomen - an increase in this symptom will be noted as the volume of the fetus increases;
• prolonged bleeding;
• severe dizziness;
• nausea;
• general weakness.

The symptoms of other, less common forms of this pathology will practically not differ in any way from the above clinical manifestations.

To avoid the development of complications, it is necessary to seek qualified help from a gynecologist even at the stage of the first discomfort.

Diagnostics

Given that in the vast majority of cases, ectopic pregnancy occurs due to gynecological problems, the basis for diagnosis is an examination by a specialist.

In severe cases of the disease, immediately after this the patient is sent for an ultrasound to determine the location of the fetal egg, and before that, blood is drawn to determine the level of hCG, which confirms pregnancy.

In situations where a woman’s condition is satisfactory, it is necessary to carry out a whole range of diagnostic measures. It follows from this that the primary diagnosis will consist of:

1. familiarization with the medical history - this can accurately determine the etiological factor.
2. performing a thorough physical examination, including palpation of the abdomen, as well as measurement of temperature, blood pressure and pulse.
3. performing a gynecological examination.
4. a detailed survey of the patient - to determine the presence, first time of occurrence and severity of symptoms.

The following laboratory tests have the greatest diagnostic value:

• a general blood test will show a change in composition;
• biochemical blood test - will help determine which pathological process led to the ectopic pregnancy;
• general clinical urine analysis - to monitor the functioning of the organs that make up the genitourinary system.

Instrumental examinations include:

1. Ultrasound of the peritoneal and pelvic organs will indicate the location of the ectopic pregnancy.
2. radiography.
3. CT and MRI - such procedures are performed as additional means in case of questionable ultrasound data.

Ectopic pregnancy must be differentiated from:

• inflammation of the appendix;
• ovarian apoplexy;
• other ailments of the abdominal cavity or pelvis requiring immediate surgical intervention.

Treatment

Termination of an ectopic pregnancy occurs only surgically, which involves open or laparoscopic surgery. When the fertilized egg is localized in the fallopian tube, the question of its preservation or excision along with the attached egg is decided.

The choice of surgical therapy technique is influenced by several factors:

1. the patient's desire to have children in the future.
2. a type of ectopic pregnancy.
3. the possibility of developing an adhesive process.
4. the feasibility of preserving the ovary or fallopian tube.

If heavy internal bleeding is detected during diagnosis, only laparotomy, i.e., open surgery, is indicated.

Prevention and prognosis

In order to prevent the development of a condition such as ectopic pregnancy syndrome, female representatives should adhere to the following recommendations:

• prevent or promptly treat diseases of the genitourinary system;
• avoid abortion;
• protect yourself from unwanted pregnancy only with the help of reliable contraceptives, which are recommended by a gynecologist;
• if it is necessary to interrupt the period of bearing a child, do this only in the early stages through a mini-abortion or medical termination of pregnancy;
• after a previous ectopic pregnancy, undergo a rehabilitation course;
• Visit your gynecologist regularly.

The prognosis of such a pathology is often favorable, since pronounced changes in well-being force women to consult a doctor. After the operation, you can plan for another pregnancy in about one year.